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Respiratory Pharm Flashcards

1
Q

What are the first generation H1 blockers?

A

-en/-ine or en/ate
Diphenhydramine
Dimenhydrinate
Chlorpheniramine

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2
Q

What are the uses of H1 antagonist?

A

Allergy
Motion sickness
Sleep aid

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3
Q

What are the side effects of H1 antagonists?

A

Sedation
Antimuscarinics (constipation; contra in Alzheimer’s)
Anti-alpha- adrenergic (vasodilation)

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4
Q

What are the second gen H1 blockers?

A 
-Adines
Loratidine
Fexofenadine
Desloratadine
Cetirizine
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5
Q

What are second gen used for?

A

Allergy

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6
Q

What is the advantage of second gen h1 antagonists?

A

Far less sedating than 1st gen because less entry into CNS (does not cross BBB)

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7
Q

What are the drugs for prophylaxis of asthma?

A

Salmeterol
Formoterol
They are long acting beta-2 agonists

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8
Q

What are the side effects of the long acting beta-2 agonists?

A

Tremor

Arrhythmia

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9
Q

What is theophylline?

A

A methylxanthine
Phosphodiesterase inhibitor –> perpetuates cAMP action
Blocks adenosine
Causes bronchodilation

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10
Q

What are the side effects of theophylline?

A

Cardiotoxicity
Neurotoxicity
Metabolized by P450 so increased by P450 inhibitors (macrolides, amiodarone, grapefruit juice, isoniazid, cimetidine, ritonavir, alcohol, cipro, ketoconazole, sulfonamides, gemfibrozil, quinidine)
this is a problem because theophylline has a low TI
blocks adenosine action

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11
Q

What muscarinic antagonist is used for preventing bronchoconstriction, COPD?

A

Ipratropium and tiotropium

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12
Q

What are the corticosteroids used for asthma?

A

Beclomethasone
Fluticasone
*1st line tx in chronic asthma

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13
Q

What is the MOA of beclomethasone in asthma?

A

Inhibits the synthesis of all cytokines
Inactivates Nf-kb (inducer of transcription of TNF-a)
anti-inflammatory agents

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14
Q

What are the anti leukotrienes?

A

Montelukast
Zafirlukast
Zileuton

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15
Q

What are the anti leukotrienes used for?

A

Aspirin-induced asthma

See nasal polyps

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16
Q

What is the MOA of zileuton?

A

5-lipoxygenaas pathway inhibitor

Blocks the conversion of arachnidonic acid to leukotrienes

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17
Q

What is omalizumab?

A

Monoclonal anti-IgE antibody

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18
Q

What is omalizumab used for?

A

Allergic asthma that is resistant to inhaled steroids and long acting b2 agonists

19
Q

What are guaifenisin and n-acetylcysteine?

A

Expectorants
They thin respiratory secretions and loosen mucus plugs
Does not suppress cough reflex

20
Q

What is n-acetylcysteine used for?

A

A mucolytic for CF patients

Antidote for acetaminophen OD

21
Q

What is the MOA of bosentan?

A

Competitive antagonist of endothelin-1 receptors so decreased pulmonary vascular resistance

22
Q

What is bosentan used for?

A

Pulmonary Arterial HTN

23
Q

What is dextromethorphan?

A

Antitussive

Synthetic codeine analog that antagonizes NMDA glutamate receptors.

24
Q

What are pseudophedrine and phenylephrine used for?

A

Nasal decongestant
Reduce hyperemia, edema, nasal congestion
Open obstructed Eustachian tubes

25
Q

What are the side effects?

A 
HTN
Anxiety (pseudophedrine = CNS stimulant)
26
Q

What are some of the contraindications to first gen H1 antagonists?

A

Older
Vision problems
Gait disturbances

27
Q

What is methacholine?

A

A muscarinic receptor agonist

Used in asthma challenge test

28
Q

What is the MOA of ipratropium?

A

Blocks M3 receptors in the airway smooth muscle and sub mucosal glands. (m3 works through the Gq pathway with phospholipase C and IP3/DAG)
Offers short term relief of asthma

29
Q

What is flunisolide?

A

A glucocorticoid used for asthma

30
Q

What is the most common side effect of inhaled glucocorticoids?

A

Oropharyngeal candidiasis

31
Q

What is the MOA of cromolyn and nedocromil?

A

Inhibits mast cell degranulation

32
Q

What are cromolyn and nedocromil used for?

A

Prophylaxis of acute attacks of asthma

33
Q

What are the actions of leukotrienes?

A 
Vasoconstriction 
Bronchoconstriction 
Increased vascular permeability
Mucosal edema
Mucus hypersecretion
34
Q

How do you treat Methemoglobinemia?

A

Methylene blue

35
Q

How do you treat cyanide poisoning?

A

Nitrites
Thiosulfate

(Nitrates oxidize Hb to methemoglobin to bind cyanide and remove from cytochrome oxidase– allowing it to function)
(Thiosulfate binds the cyanide bound to methemoglobin forming thiocyanate which is renally excreted)

36
Q

How do you treat CO poisoning?

A

100% O2

Hyperbaric O2

37
Q

How do you treat altitude sickness?

A

Acetazolamide (carbonic anhydrase inhibitor)

increases renal excretion of bicarb to compensate for respiratory alkalosis in high altitudes

38
Q

How do you treat RDS (neonatal)?

A

Maternal steroids prior to birth
Neonatal artificial surfactant
*NO supplemental O2

39
Q

How do you treat ARDS (adult)?

A

Pure O2

40
Q

What is the MOA of Albuterol?

A

Short-acting Beta-2 agonist

relaxes bronchial smooth muscle

41
Q

When do you use Albuterol?

A

Acute exacerbation of asthma

42
Q

What is the risk in using Dextromethorphan?

A

Mild opioid effect in excess = mild abuse potential

Antidote for OD: Naloxone

43
Q

What is the MOA of n-acetylcysteine

A

Mucolytic agent that cleaves intermolecular disulfide bonds within mucus glycoproteins

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